REQUEST AN APPOINTMENT
STEP 2: Provide PATIENT INFORMATION
Volusia Free Clinic ONLINE New Patient Application
ELIGIBILITY REQUIREMENTS
• Volusia County, Florida resident
• No health insurance of any kind
• Meet income restrictions
• Age between 18-64 yr old
Please submit the information requested below. Upon review, you will contacted as soon as possible and additional documents may be required and you will need to complete and sign some forms upon arrival for your first visit. Please contact us if you have questions or need assistance in applying. Phone: (386) 316-2771
If you are having an urgent medical problem or need medical assistance immediately, contact the nearest hospital emergency department or call 911 for emergency care.
Documents you will need to bring with you for your first visit:
- Photo ID - Driver License or official photo ID showing Volusia County Address.
- Proof of Address – Copy of official mail showing Volusia address, such as utility bill or cable bill.
- Statement of Current Income
By clicking on the Submit button below and submitting this form, the applicant certifies that the information provided is a true and complete statement, to the best of their knowledge. They understand that the information submitted is subject to verification by the Department of Health.
Our offices are not emergency rooms or walk-in clinics but are By-Appointment-Only Primary Care Clinics. Before making an appointment, please be aware that we do NOT provide Gynecology services, Mental Health care, pregnancy care, or Dental care at this time. We hope to expand our scope of services in the future. If you have any questions about what services we offer, please call us.
